Mortality risk among hemodialysis patients receiving different vitamin D analogs
Mortality risk among hemodialysis patients receiving different vitamin D analogs
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DOI：
10.1038/sj.ki.5001868
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发表时间：
2006-11-01
影响因子：
19.6
通讯作者：
Zager, P. G.
中科院分区：
文献类型：
--
作者：
Tentori, F.;Hunt, W. C.;Zager, P. G.
静脉注射维生素D是血液透析（HD）患者继发性甲状旁腺功能亢进的标准治疗方法。在营利性透析诊所中，骨化三醇组患者的死亡率高于帕立骨化醇组。Doxercalciferol是第二种维生素D2类似物，目前可用。我们评估了在Dialysis Clinic Inc.开始HD的患者中与每种维生素D类似物和缺乏维生素D治疗相关的死亡率。(DCI)，一家非营利透析提供商。在1999-2004年研究期间，我们研究了7731例患者（骨化三醇：n = 3212;帕立骨化醇：n 2087;度骨化醇：n 2432）。中位随访时间为37周。度骨化醇组（15.4，95%置信区间（13.6-17.1））和帕立骨化醇组（15.3（13.6 -16.9））的死亡率（死亡/100患者-年）相同，骨化三醇组（19.6（18.2-21.1））的死亡率更高（P < 0.0001）。在所有模型中，帕立骨化醇与度骨化醇的死亡率相似（风险比= 1.0）。在未校正的模型中，度骨化醇（0.80（0.66，0.96））和帕立骨化醇（0.79（0.68，0.92））组患者的死亡率低于骨化三醇组（P < 0.05）。在调整后的模型中，这种差异没有统计学意义。在所有模型中，未接受维生素D治疗的患者的死亡率均高于接受维生素D治疗的患者（1.2（1.1-1.3））。度骨化醇和帕立骨化醇治疗患者的死亡率几乎相同。维生素D2和D3之间的生存差异可能比以前报道的要小。
Intravenous vitamin D is standard therapy for secondary hyperparathyroidism in hemodialysis (HD) patients. In for-profit dialysis clinics, mortality was higher for patients on calcitriol compared to paricalcitol. Doxercalciferol, a second vitamin D2 analog, is currently available. We assessed mortality associated with each vitamin D analog and with lack of vitamin D therapy in patients who began HD at Dialysis Clinic Inc. (DCI), a not-for-profit dialysis provider. During the 1999-2004 study period we studied 7731 patients (calcitriol: n = 3212; paricalcitol: n 2087; doxercalciferol: n 2432). Median follow-up was 37 weeks. Mortality rates (deaths/100 patient-years) were identical in patients on doxercalciferol (15.4, 95% confidence interval (13.6-17.1)) and paricalcitol (15.3 (13.6-16.9)) and higher in patients on calcitriol (19.6 (18.2-21.1)) (P < 0.0001). In all models mortality was similar for paricalcitol versus doxercalciferol (hazard ratios = 1.0). In unadjusted models, mortality was lower in patients on doxercalciferol (0.80 (0.66, 0.96)) and paricalcitol (0.79 (0.68, 0.92)) versus calcitriol (P < 0.05). In adjusted models, this difference was not statistically significant. In all models mortality was higher for patients who did not receive vitamin D versus those who did (1.2 (1.1-1.3)). Mortality in doxercalciferol-and paricalcitol-treated patients was virtually identical. Differences in survival between vitamin D2 and D3 may be smaller than previously reported.